Suture punctal occlusion
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This is Richard Allen at the University of Iowa.
This video demonstrates permanent punctal and canalicular occlusion with the use of a suture.
The patient has a history of previous failed attempts at punctal occlusion with a cautery. Attention is directed to the upper punctum. The Westcott scissors are place into the punctum and canaliculus. An incision is made to expose the inside of the canaliculus. The Westcott's are then used to excise the canalicular epithelium. This is performed for approximately 5 mm along the canaliculus. A suture is then used to close the area of the de-epithelialized canaliculus. Performing this will result in scar formation without the canalicular epithelium. The suture used here is a 7-0 Vicryl suture. Attention is then directed to the lower lid. A punctal dilator is used to dilate a stenotic but patent punctum. The Westcott's are again placed into the punctum and canaliculus to expose the epithelium of the inside of the canaliculus. Westcott scissors are then used to de-epithelialize the canaliculus. This results in a sticky surface to heal. After de-epithelization of the canaliculus, the suture can be placed to close the canaliculus. I think this is a useful procedure in patients who fail punctal occlusion with a cautery. At the conclusion of the case, antibiotic ointment is placed three times a day. The patient will return in 2-3 weeks for reevaluation.